Natella Lauren, Bronsard Nicolas, Allia Jeremy, Hekayem Laurent, Euller-Ziegler Liana, De Peretti Fernand, Breuil Véronique
Rheumatology Universite Cote d'Azur Centre Hospitalier Universitaire (CHU) de Nice Nice France.
Orthopaedic Trauma and Spine Surgery Universite Cote d'Azur Institut Universitaire de l'Appareil Locomoteur et du Sport Nice France.
JBMR Plus. 2019 Jan 10;3(4):e10076. doi: 10.1002/jbm4.10076. eCollection 2019 Apr.
The WHO definition of osteoporosis excludes cervical fractures. Recent studies suggest that atraumatic odontoid fractures (OF) may be favored by osteoporosis but global bone status for osteoporosis diagnosis has not been described. We present a case series of patients >65 years old hospitalized for low-energy OF who had an evaluation of their bone status within 3 months after fracture, including clinical risk factors of osteoporosis, bone mineral density (BMD), vertebral fracture assessment (VFA) by dual X-ray absorptiometry, and laboratory tests. Osteoporosis was defined as a -score ≤ -2.5 on at least one site, or a bone fragility fracture associated with a -score ≤ -1 at one site. Thirty-three patients were hospitalized for OF, 30 of them as a consequence of a low-energy impact: 20 women and 10 men (mean age: 85 years). Eight patients died before bone evaluation, four refused, and six were lost to follow-up. Twelve patients were included: 11 women and one man (mean age: 83.8 years). Ten out of twelve patients fulfilled diagnostic criteria of osteoporosis, including eight with previous osteoporotic fractures (six severe fractures). Eight fulfilled specific treatment of osteoporosis criteria, but only two were treated. The mean follow-up period was 12.2 ± 4.1 months. Prior to OF occurrence, all lived at home and were independent; at the time of discharge, six went to a nursing home. At 3 months of follow-up ( = 10), one was dead and nine lived at home. At 12 months ( = 9), two were dead and seven lived at home. This study provides for the first time a classical evaluation of osteoporotic status for low-energy OF in the elderly and shows that it occurs in osteoporotic subjects. These preliminary results require larger-scale studies to determine whether OF could be considered as a severe osteoporotic fracture. © 2018 The Authors. is published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.
世界卫生组织对骨质疏松症的定义不包括颈椎骨折。近期研究表明，骨质疏松症可能易引发无创伤性齿状突骨折（OF），但尚未描述用于骨质疏松症诊断的整体骨状况。我们呈现了一组病例系列，这些患者年龄大于65岁，因低能量OF住院，并在骨折后3个月内对其骨状况进行了评估，包括骨质疏松症的临床风险因素、骨密度（BMD）、通过双能X线吸收法进行的椎体骨折评估（VFA）以及实验室检查。骨质疏松症的定义为至少一个部位的T值≤ -2.5，或一个部位T值≤ -1且伴有骨脆性骨折。33例患者因OF住院，其中30例是低能量撞击所致：20名女性和10名男性（平均年龄：85岁）。8例患者在进行骨评估前死亡，4例拒绝评估，6例失访。纳入12例患者：11名女性和1名男性（平均年龄：83.8岁）。12例患者中有10例符合骨质疏松症的诊断标准，其中8例有既往骨质疏松性骨折（6例为严重骨折）。8例符合骨质疏松症的特定治疗标准，但仅2例接受了治疗。平均随访期为12.2±4.1个月。在发生OF之前，所有患者均居家生活且生活自理；出院时，6例入住养老院。随访3个月时（n = 10），1例死亡，9例居家生活。随访12个月时（n = 9），2例死亡，7例居家生活。本研究首次对老年人低能量OF的骨质疏松症状态进行了经典评估，并表明其发生于骨质疏松症患者中。这些初步结果需要更大规模的研究来确定OF是否可被视为严重的骨质疏松性骨折。© 2018作者。本文由Wiley Periodicals, Inc.代表美国骨与矿物质研究学会发表。
